title: A systematic review of model-based economic evaluations of diagnostic and therapeutic strategies for lower extremity artery disease.
abstract: Lower extremity artery disease (LEAD) is a sign of wide spread atherosclerosis also affecting coronary, cerebral and renal arteries and is associated with increased risk of cardiovascular events. Many economic evaluations have been published for LEAD due to its clinical, social and economic importance. The aim of this systematic review was to assess modelling methods used in published economic evaluations in the field of LEAD. Our review appraised and compared the general characteristics, model structure and methodological quality of published models. Electronic databases MEDLINE and EMBASE were searched until February 2013 via OVID interface. Cochrane database of systematic reviews, Health Technology Assessment database hosted by National Institute for Health research and National Health Services Economic Evaluation Database (NHSEED) were also searched. The methodological quality of the included studies was assessed by using the Philips' checklist. Sixteen model-based economic evaluations were identified and included. Eleven models compared therapeutic health technologies; three models compared diagnostic tests and two models compared a combination of diagnostic and therapeutic options for LEAD. Results of this systematic review revealed an acceptable to low methodological quality of the included studies. Methodological diversity and insufficient information posed a challenge for valid comparison of the included studies. In conclusion, there is a need for transparent, methodologically comparable and scientifically credible model-based economic evaluations in the field of LEAD. Future modelling studies should include clinically and economically important cardiovascular outcomes to reflect the wider impact of LEAD on individual patients and on the society.
authors.affiliation: Anil Vaidya, Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre plus, PO Box 5800, 6202 AZ Maastricht, The Netherlands, Tel.: +31433874483, Fax: +31433874419, E-mail: a.vaidya@maastrichtuniversity.nl.
authors.forename: Anil
authors.initials: A
authors.lastname: Vaidya
authors.forename: Manuela A
authors.initials: MA
authors.lastname: Joore
authors.forename: Arina J
authors.initials: AJ
authors.lastname: ten Cate-Hoek
authors.forename: Marie-Claire
authors.initials: MC
authors.lastname: Kleinegris
authors.forename: Hugo
authors.initials: H
authors.lastname: ten Cate
authors.forename: Johan L
authors.initials: JL
authors.lastname: Severens
mesh_terms: D050197:Atherosclerosis / Q000150:complications / Q000191:economics; D002309:Cardiology / Q000191:economics; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D018450:Disease Progression; D017048:Health Care Costs; D006801:Humans; D035002:Lower Extremity / Q000473:pathology*; D018803:Models, Economic; D058729:Peripheral Arterial Disease / Q000175:diagnosis* / Q000191:economics* / Q000628:therapy*; D011788:Quality of Life
keywords: Lower extremity artery disease; decision analytic model; economic evaluation; systematic review